33 year old woman with sore throat, increasing fatigue & SOB

[Oak]

I am glad that our discussion lead to create a separate forum for people like us who love MCQs, its better now atleast our friends can navigate the MCQs easily they don't have to next page again and again.

So, here we go now:

A 33 year old woman complains of a sore throat, increasing fatigue, and shortness of breath for the past three days. On physical examination, her temperature is 101.5 F and her heart rate is 100, with no murmurs. A CBC with reticulocyte count shows 1500 white blood cells/mm3. The platelet count is 12 x 109/L. Bone marrow aspiration and biopsy demonstrates cellularity less than 25%, and the corrected reticulocyte count is less than 1%. Which of the following is the most likely diagnosis?

A. Anemia of chronic disease
B. Aplastic anemia
C. Myelodysplasia with myelofibrosis
D. Myelophthisic anemia
E. Pure red cell aplasia

[Hero]

B. Aplastic anemia

[Oak]

thats right the correct answer is B. Aplastic anemia is characterized by pancytopenia. The bone marrow biopsy typically reveals a normal architecture with a decrease in cellularity to levels less than 25% of normal. The corrected reticulocyte count (i.e., reticulocyte count × patient's hematocrit/45) is often 1%. Platelet counts range from 20 to 60 × 109/L, and the absolute neutrophil counts are often less than 0.5 × 109/L. Aplastic anemia may be either hereditary (e.g., Fanconi's anemia) or acquired. Certain pharmacologic agents, such as busulfan and vincristine, often produce severe marrow hypoplasia or aplasia. Chloramphenicol, some anticonvulsant drugs, phenylbutazone, and a variety of other agents may produce aplastic anemia in an idiosyncratic manner. Aplastic anemias have also been linked to exposure to environmental toxins, such as benzene and insecticides, and are often found to be preceded by viral infections from cytomegalovirus, parvovirus, and hepatitis. The fever and sore throat in the patient described in the question are consistent with cytomegalovirus infection.

Anemia of chronic disease (choice A) produces an isolated deficit of red cell production and may resemble iron deficiency.

The myelodysplastic syndromes (e.g., myelodysplasia with myelofibrosis, choice C) are characterized by replacement of the bone marrow with abnormal (dysplastic) stem cells and ineffective hematopoiesis.

Myelophthisic anemia (choice D) is caused by infiltration of the bone marrow by expansile lesions (e.g., metastatic carcinoma) that distort the marrow architecture and generally depress the production of all three types of formed blood elements.

Pure red cell aplasia (choice E) would produce a selective deficit of the erythrocytic lineage, not all three lineages.